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Permit (81) CITY OF TIGARD ELECTRICAL PERMIT ``1 , ' COMMUNITY DEVELOPMENT Permit#: ELC2017-00796 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2017 Parcel: 2S103DA02000 Jurisdiction: Tigard Site address: 10865 SW DERRY DELL CT Project: Howe Subdivision: DERRY-DELL NO.2 Lot: 21 Project Description: (1)branch circuit for new gas furnace. Contractor: OWNER Owner: JORDAN AND RACHEL HOWE JORDAN &RACHAEL HOWE 10865 SW DERRY DELL CT 10865 SW DERRY DELL TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 971-228-9512 PHONE: 971-228-9512 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 10/24/2017 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 10/24/2017 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio. - Those rules 'are set forth in O 952-001-0010 through OAR 952-001-0090. You ma obtain a...y of the rue .r direct questions to OUNC by callin. •. 1.8 33222..2 3 Issued By: s!-- _ _ •er - '.nature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. . Electrical Permit Application FOR OFFICE USE ONLY 1 - City of Tigard R- . 14 it 13125 SW Hall Blvd.,Tigard,OR 972 F� r Date/B : / /���� .?lf�/�i� Phone: 503.718.2439 Fax: 503.598. .1R:lJ . 1 Plan Review Date/B Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Juris: it2( `� «~' ® See Page 2 for TIGARD Internet www.tigard-or.govNotified/Method: n�� �y ���� Nottfied/Method Supplemental Information 1- i� II i a4 P 11 E1OI WORKQ-� ,2 4 ;� . 4=i r Vii- qii❑New ®Addition/alteraa l TIGARD s 'I ,p,;PL i2 setsfp ,ii r. ,Iked): . 1„ 0 New constructionriPlease check all that apply(submit 2 sets of plans w/items checked): 0 Other: ii��� it ,�� �_ � 7, l',';.,,,,,,, � i � i ❑Service or feeder 400 amps or more 0 Building over three stories. C,5.TECQR ,eve-- C fi I I, ! 8 I � ,* , where the available fault current 0 Marinas and boatyards. exceeds 10,000c 1 so volts or 0 Floating buildings.® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessorybuilding less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Multi family 0 Master builder 0 Other: amps for all other installations. buildings. CAT J 1a aI B' ITF 1 P(ijZ T j jj'.) QC Q , ❑Fire pump. 0 Installation of 150 KVA or Job#:NA ❑Emergency system. larger separately derived I Job site address: 10865 SW DERRY DELL CT ❑Addition of new motor load of system. City/State/ZIP:TIGARD/OREGON/97223 100HP or more. ❑"A","E",°`1-z",°`1-3", ❑Six or more residential units. occupancy. Suite/bldg./apt.#:NA I Project name:NA ❑Health-care facilities. 0 Recreational vehicle parks. 0 Hazardous locations. 0 Supply voltage for more than Cross street/directions to job site:99W,N on PARK ST,R on DERRY DELL CT ❑Service or feeder 600 amps or more. 600 volts nominal. 1:7 4f i h.-'7 4 LL f k'HEII4*: fr � N n�.0 Description Qty. I Each I Total Subdivision: I Lot#: New residential single-or multi-family dwelling unit. Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 7r1'1 1' Pi7 „r ;I ,!' 'PI it k SCR1pTIO1 o ©IWW (I 0el' . gra Ea.add'l 500 sq.ft.or portion 33.92 1 INSTALLATION OF NEW GAS FURNACE AND GAS LINES(METER TO Limited energy,residential FURNACE) (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 M l� ':ti.�0:ToC n`Yf oW(t11 R Syap ,, w ,' ai ii f�' d TE1 % 4Tl r „tiY'` 4 gY ❑ See Page 2 SerRenewablevices or feeders installation,alteration,and/or relocation Name:JORDAN HOWE 200 amps or less 100.70 2 Address: 10865 SW DERRY DELL CT 201 amps to 400 amps 133.56 2 City/State/ZIP:TIGARD/OREGON/97223 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:( )971-228-9512 I Fax:(NA) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,1. s r:xch7ge,Vilding to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature Date: .0 q 7- 401 amps to 599 amps 168.54 2 flti v=sA vj,l , Gi` ;i 4:T frs omitA ; l) i' Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name:NA above service or feeder fee, Contact name:JORDAN HOWE each branch circuit 7.42 2 B.Fee for branch circuits without 1Address: 10865 SW DERRY DELL CT service or feeder fee,first branch circuit 56.18 56,t i 2 City/State/ZIP:TIGARD/OREGON/97223 Each add'l branch circuit 7.42 2 Phone:( )971-228-9512 I Fax: :(NA) Miscellaneous(service or feeder not included) Each manufactured or modular dwelling,service and/or feeder Email:JORDAN.LOWERY.HOWE@GMAIL.COM 67.84 2 Reconnect only 67.84 2' ii � ��_i� m �" ���OI1 )l - i Pump or irrigation circle 67.84 2 Business name:NA-NO CONTRACTOR Sign or outline lighting 67.84 2 Address:NA Signal circuit(s)or limited-energy panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP:NA Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(NA) I Fax:(NA ) Investigation(1 hr min) 90.00/hr Email:NA Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: NA I Electrical Lic.: NA I Suprv.Lic.: NA specifically listed(V hr min) 90.00/hr Suprv.Electrician signature,required: 1 :O: 1T 1M " w f,Tf' Subtotal: 5 6„i t Print name: NA Date: NA ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 6,.-ill Authorized signature: TOTAL PERMIT FEE: 6),_tv,, This permit application expires if a permit is not obtained within 180 Print name: I Date: days after it has been accepted as complete. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: rte_ �_ r Description Qty. I Each I Total ry` Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7 42 3 >100 kva-no additional charge 0.0 3 ❑ Vacuum Systems* Each additional inspection over allowable in any of the above: Each additional inspection is 66.25/hr 1 ❑ Other: charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('h hr mm) ' LECC, PRT ES i tr 1 'ill „ �' COMMERCIAL W, = Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 $ Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10865 SW DERRY DELL CT, TIGARD, OR, 97223 Record Type: Record ID: Residential - Electrical ELC2017-00796 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor